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Manager, Clinical Adjudication – Prior Authorization Solutions

ManagerManagerFull TimeRemoteTeam 10,001+Since 1963H1B No SponsorCompany Site LinkedIn

Location

Arizona + 3 more

Posted

29 days ago

Salary

$60.3K - $145.9K / year

Bachelor Degree5 yrs expExperience acceptedEnglish

Job Description

• Lead and close deliverables related to department initiatives and PA activities in a timely manner • Support CAPAS service catalog offerings • Maintain CAPAS service-related job aids and documentation • Drive innovative improvements across CAPAS operations • Validate functionality of new programs and innovations • Support implementation of client PA files during the clinical review portion of member data transitions • Assist partners in understanding adjudication claim processing • Provide training and cross-training to internal CAPAS team members, including new hires and advanced deep-dive sessions

Job Requirements

Minimum 5 years of experience with RxClaim, specifically in adjudication related to Prior Authorization overrides
Experience running queries in RxClaim and/or Data Warehouses
Advanced proficiency in Microsoft Office Suite, particularly Excel, Access, and Visio
Knowledge of CVS Caremark clinical programs (e.g., Benefit plan setup, formularies, utilization management) (Preferred)
Experience developing or enhancing training materials (Preferred)
Familiarity with Microsoft Power Platform (Preferred)
Bachelor’s degree required; equivalent work experience may substitute

Benefits

Affordable medical plan options
401(k) plan (including matching company contributions)
Employee stock purchase plan
No-cost programs for all colleagues including wellness screenings, tobacco cessation and weight management programs, confidential counseling and financial coaching.
Paid time off
Flexible work schedules
Family leave
Dependent care resources
Colleague assistance programs
Tuition assistance
Retiree medical access